Microeconomic analyses of the health of the elderly in China

China is currently facing unprecedented health challenges; non-communicable diseases (NCD) now account for 80 percent of its 10.3 million deaths annually. China’s growing health challenges arise, at least in part, due to its rapidly aging population and are compounded by its inadequate social security provision and rapid urbanization. This dissertation examines the extent to the health and well-being of the elderly in China are affected in the presence of these demographic and social changes. It uses data from a rich but relatively underutilized data source, the China Health and Retirement Longitudinal Study (CHARLS). CHARLS is the first Health and Retirement Study (HRS) of its kind in China, and as such represents a rich source of data on health and well-being for the country. A two-province sample was piloted in 2008 and followed up in 2012, while a national wave was surveyed in 2011. This dissertation is a collection of three self-contained empirical studies on the health and well-being of the elderly in China. The first study examines the effect that chronic diseases have on different dimensions of health in a structural equation framework. The second study examines the extent to which elderly households are able to continue to finance their consumption in the presence of ill-health and the extent to which health insurance and family support from children play a role. In the last study, we further investigate the effect that adult children’s migration decisions have on the physical and subjective well-being of their elderly parents

Microeconomic analyses of the health of the elderly in China

China is currently facing unprecedented health challenges; non-communicable diseases (NCD) now account for 80 percent of its 10.3 million deaths annually. China’s growing health challenges arise, at least in part, due to its rapidly aging population and are compounded by its inadequate social security provision and rapid urbanization. This dissertation examines the extent to the health and well-being of the elderly in China are affected in the presence of these demographic and social changes. It uses data from a rich but relatively underutilized data source, the China Health and Retirement Longitudinal Study (CHARLS). CHARLS is the first Health and Retirement Study (HRS) of its kind in China, and as such represents a rich source of data on health and well-being for the country. A two-province sample was piloted in 2008 and followed up in 2012, while a national wave was surveyed in 2011. This dissertation is a collection of three self-contained empirical studies on the health and well-being of the elderly in China. The first study examines the effect that chronic diseases have on different dimensions of health in a structural equation framework. The second study examines the extent to which elderly households are able to continue to finance their consumption in the presence of ill-health and the extent to which health insurance and family support from children play a role. In the last study, we further investigate the effect that adult children’s migration decisions have on the physical and subjective well-being of their elderly parents

Health literacy and its effect on chronic disease prevention: evidence from China’s data

Background: Improving health literacy is an important public health goal in many countries. Although many studies have suggested that low health literacy has adverse effects on an individual’s health outcomes, confounding factors are often not accounted. This paper examines the interplay between health literacy and chronic disease prevention. Methods: A population-based sample of 8194 participants aged 15–69 years old in Ningbo were used from China’s 2017 National Health Literacy Surveillance Data. We use multivariate regression analysis to disentangle the relationship between health literacy and chronic disease prevention. Results: We find the association between health literacy and the occurrence of the first chronic condition is attenuated after we adjust the results for age and education. This might arise because having one or more chronic conditions is associated with better knowledge about chronic diseases, thus improve their health literacy. More importantly, we find health literacy is associated with a reduction in the likelihood of having a comorbid condition. However, this protective effect is only found among urban residents, suggesting health literacy might be a key factor explaining the rural-urban disparity in health outcomes. Conclusion: Our findings highlight the important role of health literacy in preventing comorbidities instead of preventing the first chronic condition. Moreover, family support could help improve health literacy and result in beneficial effects on health

The economic costs of limited health literacy in China: evidence from China’s National Health Literacy Surveillance data

BACKGROUND: Limited health literacy is a public health challenge contributing to the rising health care costs. We assess the economic costs of limited health literacy in China using data from the National Health Literacy Surveillance survey. METHODS: Our data includes a sample of 6316 residents aged 15–69 years old living in Ningbo, China, in 2019. We use box plots to examine the distribution of out-of-pocket health expenditure by the level of health literacy. We then use the estimates from a two-part model to assess the contribution of limited health literacy to individual medical spending and the aggregate health expenditure at different levels of health literacy for the adult population in Ningbo. RESULTS: Medical costs of limited health literacy are about 10% (177 CNY or about 25 USD) of the annual medical expense of a resident aged 15–69 living in Ningbo. The medical cost of limited health literacy is greater among the rural, female, and older groups than others. If the proportion of people with adequate health literacy increases from 22 to 30% (the target level by 2030), the aggregate out-of-pocket health expenditure in Ningbo will decrease by 100 million CNY (14 million USD), or 0.88% of the 2019 Ningbo government expenditure on health care. CONCLUSIONS: This paper highlights the direct and indirect economic costs associated with limited health literacy. The results should help policymakers evaluate the cost-effectiveness of relevant programs that aim to improve residents’ health literacy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-07795-9

The Community Health Supporting Environments and Residents’ Health and Well-Being:The Role of Health Literacy

We evaluate the impacts that health supporting environments have on residents’ health and well-being. Using a stratified multi-stage sampling method, we select a sample of 12,360 permanent adult residents aged 15–69, and collect information on their health literacy level, as well as their demographic background and health. This individual level data is then merged with the administrative health supporting environment data. More than two thirds of residents self-reported having good/excellent health, and the percent of adults living in communities with healthy parks, healthy trails, and healthy huts in their community is 23 percent, 43 percent, and 25 percent, respectively. Controlling for a series of confounding factors at the community and individual levels, we find that healthy parks and healthy trails are positively correlated with self-reported health, which increases the probability of self-reporting good health by 2.0 percentage points (p < 0.10) and 6.0 percentage points (p < 0.01), respectively. Access to healthy huts is negatively associated with self-reported health, decreasing the probability of self-reporting good health by 5.0 percentage points (p < 0.01). Health literacy plays a role in moderating the effect of health parks, and a positive effect is more likely to be observed among adults with lower health literacy. Health supporting environments may play a role in reducing the likelihood of undiagnosed diseases and changing residents’ lifestyles, which promotes the health and well-being of residents, especially among those with inadequate health literacy

Health literacy and its effect on chronic disease prevention: evidence from China’s data

Background: Improving health literacy is an important public health goal in many countries. Although many studies have suggested that low health literacy has adverse effects on an individual’s health outcomes, confounding factors are often not accounted. This paper examines the interplay between health literacy and chronic disease prevention. Methods: A population-based sample of 8194 participants aged 15–69 years old in Ningbo were used from China’s 2017 National Health Literacy Surveillance Data. We use multivariate regression analysis to disentangle the relationship between health literacy and chronic disease prevention. Results: We find the association between health literacy and the occurrence of the first chronic condition is attenuated after we adjust the results for age and education. This might arise because having one or more chronic conditions is associated with better knowledge about chronic diseases, thus improve their health literacy. More importantly, we find health literacy is associated with a reduction in the likelihood of having a comorbid condition. However, this protective effect is only found among urban residents, suggesting health literacy might be a key factor explaining the rural-urban disparity in health outcomes. Conclusion: Our findings highlight the important role of health literacy in preventing comorbidities instead of preventing the first chronic condition. Moreover, family support could help improve health literacy and result in beneficial effects on health

Health literacy and its effect on chronic disease prevention: evidences from China's national health literacy surveillance data

Objectives Improving health literacy is an important public health goal in many countries. Although many studies have suggested that low health literacy has adverse effects on an individual’s health outcomes, factors that may be confounding the relationship between health literacy and health outcomes are often not accounted. This paper examines the interplay between health literacy and chronic disease prevention. Methodology A sample of 2,835 residents aged 14-71 years old in Ningbo province of China were selected from China’s National Health Literacy Surveillance Survey in 2017. The multivariate regression analysis is used to untangle the relationship between health literacy and chronic disease prevention. Results We find the association between health literacy and the occurrence of the first chronic condition is attenuated after we adjust the results for age and education. In contrast, we find having one or more chronic conditions leads to better knowledge about chronic diseases and thus improved health literacy on chronic disease prevention. Thus, when a respondent has one chronic disease, health literacy could reduce the incidence of a new chronic condition (comorbidities). However, the protective effect of health literacy is only found among our urban sample, suggesting health literacy might be a key factor explaining the rural-urban disparity in health outcomes. Conclusion Our findings highlight that health literacy plays a more important role in helping individuals preventing comorbidity than preventing their first chronic disease. Moreover, family support could be a potential channel through which health literacy accumulates and results in beneficial effects on health

TERT promoter methylation is associated with high expression of TERT and poor prognosis in papillary thyroid cancer

The telomerase reverse transcriptase (TERT) is overexpressed and associated with poor prognosis in papillary thyroid cancer (PTC), the most common subtype of thyroid cancer. The overexpression of TERT in PTC was partially attributed to transcriptional activation by two hotspot mutations in the core promoter region of this gene. As one of the major epigenetic mechanisms of gene expression regulation, DNA methylation has been proved to regulate several tumor-related genes in PTC. However, the association of TERT promoter DNA methylation with TERT expression and PTC progression is still unclear. By treating PTC cell lines with demethylating agent decitabine, we found that the TERT promoter methylation and the genes’ expression were remarkably decreased. Consistently, PTC patients with TERT hypermethylation had significantly higher TERT expression than patients with TERT hypomethylation. Moreover, TERT hypermethylated patients showed significant higher rates of poor clinical outcomes than patients with TERT hypomethylation. Results from the cox regression analysis showed that the hazard ratios (HRs) of TERT hypermethylation for overall survival, disease-specific survival, disease-free interval (DFI) and progression-free interval (PFI) were 4.81 (95% CI, 1.61-14.41), 8.28 (95% CI, 2.14-32.13), 3.56 (95% CI, 1.24-10.17) and 3.32 (95% CI, 1.64-6.71), respectively. The HRs for DFI and PFI remained significant after adjustment for clinical risk factors. These data suggest that promoter DNA methylation upregulates TERT expression and associates with poor clinical outcomes of PTC, thus holds the potential to be a valuable prognostic marker for PTC risk stratification

The impact of child migration on the health and well-being of parents left behind

This paper uses data from the China Health and Retirement Survey to estimate the causal effect child out-migration has on the health of parents in China. For rural parents, we show that after controlling for self-selection, child out-migration has a detrimental effect not only on subjective well-being and mental health but also on cognitive function and physical health when measured using a series of clinical tests and health biomarkers. In contrast, for urban parents, only a few health effects are significant, and those that are tend to be positive. In terms of the mechanism through which migration affects parental health, we find that it is differences in the level of physical support that parents require that is central to explaining many of the health effects we observe. For those who require little physical support, the income effect helps to mitigate the negative effects associated with child out-migration, while for more vulnerable groups of parents, the economic benefits of migration are currently no substitute for the loss of informal support networks when a child migrates